HomeMy WebLinkAboutMiscellaneous - 101 GREAT POND ROAD 4/30/2018I
11
Date?��f n............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
;,SSACMUS�
This certifies that -4"r.... . ...... ............................... ,......
has permission to perform ..=7:: �" .. .
wiring in the buildin��� _f'c :........::.:..:........ ,.V..........................................
/ ; -
at .. '. ........ zf . , North Andover, Mass.
R Fee .......... Lic. Nor?�G � ....... ,`'` -..
�EiCr�;��A� M iC
Check #
8034
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a
Commcnweaith of Massachusetts Official Use Only
Department of ,tire Services hermit No. ,pD3 y
BOARD OF FIRE PREVENTION REGULgTIONS Occupancy and Fee Checked �-9,.
f4 [Rev. 11/99] ' (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrizai Code ( lEC), �'27 CMR 12.00
(PLEASE PRIfVT IN INK_ OR TYPE ALL INFORi'114.TION) Date:
City or Town of: j joA A&Jbc4.Q,0, To the Inspector offire.s:
By this application the undersigned gives notice of his or 1her intention to perform the electrical work described below.
Location (Street & Number) l Q [
Owner or Tenant ' 71, 40 RF_ + IMMrt,1, C-10 N Telephone No. ., 6 3 V//i
Owner's Address rJ' 1P�% 0.S A�OoYC.
Is this permit in conjunction with a building permit'?. Yes ❑ No (Check Appropriate BoY)
Purpose of'Buiiding
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Utility Authorization No.
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
Completion ofthe followin.v table may be waived by the Inspector of Wires.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Liahtin- Fixtures
b b
Swimmin- Pool Above ❑ In- ❑
b arnd. �rnd.
o. o cy Lighting
Batter Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARNIS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
INo. of Air Cond. Tonal
No. of Alerting Devices
No. of Waste Disposers
Heat Pum Number
Totals
Tuns
"'
KW
" "'
No. of Self -Contained
DetectioniAlerting .Devices
No. of Dishwashers
Space/Area Heating KW
Local [INlunici Connectial on ❑Other
No. of Dryers
Heating Appliances
3 ` pp KW
Security Systems:
No. of Devices or Ecuivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
' No. of Devices or E uivalent'
OTHER:
Attach additional detail if desired, or as required by the Inspector oj'Wires.
INSURANCE COV-ERAGE: Unless waived by the owner, no permit for the performance of electricall work may issue unless
r the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
' CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
M
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: AT Inspections to be requested in accordance with NEC Rule 10, and upon completion.
I certify, under the pains and penalties ofperjury, that the information on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: :�:Gm Ann Signature LIC. NO.:gjr,19.5F—
(If applicable, enter "exempt" id the license number line) Bus. Tel. No.:978 72Y 6Zu
Address: _ items J@ ADA Af j 91ktye 64I NIn O! $32- Alt. Tel. No.:
OWNER'S INSURANCE WAIVER:l I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑owner's agent.
Owner/Agent Telephone No. PERMITE�: r �,
Signature P �-1
I
IN
Location '/ c�'�%��� �� I�,N .
No. ?c��!' Date
TOWN OF NORTH ANDOVER
`—T,Sewer Connection Fee $
Y
Water. ,Connection Fee $
' `iTOTAL $
A10Q 1991
0'if I Building Inspector
�j , r.
Div. Public Works
p Certificate of Occupancy $
Building/Frame Permit Fee $
Eta' Foundation Permit Fee $
Other Permit Fee $
`—T,Sewer Connection Fee $
Y
Water. ,Connection Fee $
' `iTOTAL $
A10Q 1991
0'if I Building Inspector
�j , r.
Div. Public Works
CL
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